C1 Posterior Arch Screws for the Additional Reinforcement of Upper Cervical Spine Fixation: Surgical Technique and Preliminary Case Series

Guanyi Liu; Jing Wang; Lihua Hu; Miao Zhu; Jiayu Zhang; Weihu Ma; Yong Hu; Qing Li

doi:10.1016/j.wneu.2025.123680

C1 Posterior Arch Screws for the Additional Reinforcement of Upper Cervical Spine Fixation: Surgical Technique and Preliminary Case Series

World Neurosurg. 2025 Jan 13:123680. doi: 10.1016/j.wneu.2025.123680. Online ahead of print.

Authors

Guanyi Liu¹, Jing Wang², Lihua Hu³, Miao Zhu⁴, Jiayu Zhang¹, Weihu Ma¹, Yong Hu¹, Qing Li⁵

Affiliations

¹ Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, People's Republic of China.
² Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, People's Republic of China.
³ Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China.
⁴ Department of Anesthesiology, Ningbo No.6 Hospital, Ningbo, People's Republic of China.
⁵ Department of Endocrinology, Yinzhou No.2 Hospital, Ningbo, Zhejiang 315040, China. Electronic address: liqing877@126.com.

PMID: 39814174
DOI: 10.1016/j.wneu.2025.123680

Abstract

Objective: This study aims to evaluate the clinical outcomes of utilizing C1 posterior arch screws (PAS) combined with C2 translaminar screws as an adjunct for reinforcing upper cervical spine fixation.

Methods: A retrospective analysis was conducted on four male patients who underwent surgery involving C1 PASs and C2 translaminar screws between January 2022 and February 2024. Surgical technique involved the insertion of standard C1 lateral mass screws (LMS) and C2 pedicle screws, followed by the placement of C1 PASs and C2 translaminar screws for additional fixation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI), while radiological assessment focused on fracture union and fusion.

Results: The mean age of the patients was 56.2 ± 7.0 years, with a mean follow-up duration of 12.5 months. There were no intraoperative or postoperative complications. The average operative time was 100 ± 21.2 minutes, and the average intraoperative blood loss was 65 ± 17.6 mL. Postoperatively, VAS scores showed a significant decrease from 5.7 ± 0.7 to 1.0 ± 0.7 (p < 0.05), and NDI scores improved from 77.0 ± 4.2 to 7.5 ± 4.2 (p < 0.05). The radiographic evaluation confirmed fracture union and fusion in all patients except one who passed away three months postoperatively due to complications related to COVID-19.

Conclusions: Unilateral or bilateral C1 PASs combined with C2 translaminar screws, demonstrated successful outcomes in this small patient series. C1 PASs effectively served as additional reinforcement for C1 lateral mass screws, enhancing upper cervical spine fixation.

Keywords: C1 posterior arch screw; C1 screw; C1–2 instrumentation; atlantoaxial fixation.